The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn.

Bauman Z, Nanagas V - Case Rep Pediatr (2015)

Bottom Line:
In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure.Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course.Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

ABSTRACTWe encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

fig1: Upper gastrointestinal small bowel follow-through at 4 hours showing dilated loops of proximal small bowel and no progression of contrast through to the colon, suggestive of small bowel obstruction.

Mentions:
The patient remained hemodynamically stable with nasogastric decompression and parenteral nutrition. He continued to demonstrate high output from the nasogastric tube, which, over the course of his first three weeks of life, became more mucus-like and nonbilious. His abdomen remained mildly distended but, as Snyder et al. pointed out, patients can often suffer from severe ileus for up to 3 to 4 weeks after closure of the gastroschisis [7]. Further studies have also demonstrated prolonged ileus from closure of a gastroschisis. A study from 2000 by Driver et al. showed the median time to full oral feedings and resolution of ileus was 30 days (range: 5 to 160 days) [8] and a 2011 study by Bradnock et al. showed a median duration of 21 days (range: 9 to 39 days) to reach full oral intake [9]. For this reason, we never became alarmed as we felt our patient was just suffering a prolonged ileus. However, as the patient approached four weeks since the initial gastroschisis closure, the concern for a possible bowel obstruction became evident as the patient never developed any further bowel function since the original passage of meconium at the initial surgery. Therefore, an upper gastrointestinal study with small bowel follow-through was obtained (Figure 1). The study demonstrated multiple dilated loops of proximal small bowel, consistent with a small bowel obstruction. Therefore, on day of life 27, the decision was made to take the patient back to the operating room for exploratory laparotomy.

fig1: Upper gastrointestinal small bowel follow-through at 4 hours showing dilated loops of proximal small bowel and no progression of contrast through to the colon, suggestive of small bowel obstruction.

Mentions:
The patient remained hemodynamically stable with nasogastric decompression and parenteral nutrition. He continued to demonstrate high output from the nasogastric tube, which, over the course of his first three weeks of life, became more mucus-like and nonbilious. His abdomen remained mildly distended but, as Snyder et al. pointed out, patients can often suffer from severe ileus for up to 3 to 4 weeks after closure of the gastroschisis [7]. Further studies have also demonstrated prolonged ileus from closure of a gastroschisis. A study from 2000 by Driver et al. showed the median time to full oral feedings and resolution of ileus was 30 days (range: 5 to 160 days) [8] and a 2011 study by Bradnock et al. showed a median duration of 21 days (range: 9 to 39 days) to reach full oral intake [9]. For this reason, we never became alarmed as we felt our patient was just suffering a prolonged ileus. However, as the patient approached four weeks since the initial gastroschisis closure, the concern for a possible bowel obstruction became evident as the patient never developed any further bowel function since the original passage of meconium at the initial surgery. Therefore, an upper gastrointestinal study with small bowel follow-through was obtained (Figure 1). The study demonstrated multiple dilated loops of proximal small bowel, consistent with a small bowel obstruction. Therefore, on day of life 27, the decision was made to take the patient back to the operating room for exploratory laparotomy.

Bottom Line:
In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure.Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course.Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.

ABSTRACTWe encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia.